OrthoACCESS 2.0: Redesigning a National Orthopaedic Surgery Curriculum for Medical Students using a Flipped-Classroom Blended Learning Model

Objective

Due to limited musculoskeletal education, students pursuing orthopaedic surgery often feel unprepared for residency. Clinical rotations provide some education; however, prior to the development of the Ortho Acting-Intern Coordinated Clinical Education and Surgical Skills (OrthoACCESS) curriculum in 2019, no standardized didactic curriculum existed. Over time, students desired interactive, case-based learning opportunities. Our objective was to design a flipped-classroom, blended learning curriculum and evaluate its ability to improve medical student orthopaedic knowledge.

Design

OrthoACCESS 2.0 is a 16-week, open-access curriculum consisting of didactic lectures, case discussions, and learning resources.

The curriculum was evaluated using pre-curriculum, post-case discussion, and post-curriculum surveys. Likert-item questions were evaluated with paired Wilcoxon signed-rank analysis. Free text responses were reviewed for emerging themes.

Setting

Lectures were presented weekly in-person for students at OrthoACCESS institutions with pre-recorded lectures available for non-rotating students. Faculty-led virtual case discussions consisted of 3 case presentations and breakout rooms for discussion. Learning resources (e.g., Anki Cards, “scut sheets”) were posted to the website.

Participants

OrthoACCESS 2.0 was hosted from June to October 2023 with 35 participating institutions. All 226 student registrants completed the pre-curriculum survey and 69 completed the post-curriculum survey. Forty students attended at least 8/16 case discussions.

Results

In the post-curriculum survey, 68% of participants reported “quite” or “extremely” strong orthopedic knowledge, compared to 23% beforehand (p < 0.001). Postcase discussion surveys revealed significant increases in knowledge associated with each lecture and case discussion (p < 0.001). The greatest student-reported benefits were the broad coverage of orthopedic topics (n=41) and learning how to think like an orthopaedic surgeon (n=20). The greatest barrier to attendance was clinical obligations during case discussions (n=44).

Conclusions

This flipped-classroom, blended learning curriculum has improved medical student foundational orthopaedic knowledge nationally. This model may be valuable for other specialties with limited undergraduate medical exposure.